7.2 Skin barrier as a potential target for treatment – new
developments
The disturbed skin barrier offers a variety of novel leverage points for
future AE treatment. One option would be to tackle the dysbalanced skin
microbiome with pre- and probiotics. A study achieved positive results
by applying heat-treated Lactobacillus johnsonii NCC 533 on AE
skin [118]. The topical microbiome transplant of Roseomonas
mucosa from healthy participants to AE patients improved AE severity in
a clinical I/II safety and activity trial [119]. As S. aureusis one of the driving factors in AE, multiple strategies to controlS. aureus growth emerged. An active reduction of S. aureuscould be achieved with competing coagulase negative staphylococci (CoNS)
which produce antimicrobial peptides against S. aureus [120].
Furthermore, it could be shown that CoNS could inhibit quorum sensing
and thereby virulence of S. aureus [121, 122]. Another
strategy is to shift the microenvironment towards unfavorable conditions
for S. aureus . As acidic and alkaline pH seems to limit the
growth of S. aureus in vitro and in vivo, acidification of the
skin could be one strategy. However, sustained acidification of the skin
was not yet successful [64, 123]. Therefore, more acidic products,
well-buffered products or a more continuous application of the emollient
could be beneficial. Dilute bleach baths also do not reduce S.
aureus load and AE severity in vivo or in vitro [64, 95, 123, 124].
Contrastingly, removal of S. aureus by UVB is known to be quite
successful [125]. An exciting new strategy in AE management could
also be an anti-S. aureus vaccine [126].